NCLEX-RN
NCLEX RN Exam Questions Questions
Extract:
Question 1 of 5
The nurse is planning dietary changes for a client following an episode of acute pancreatitis. Which diet is suitable for the client?
Correct Answer: B
Rationale: A high-calorie, low-fat diet supports recovery from pancreatitis by reducing pancreatic stimulation while meeting energy needs. High-fat diets exacerbate symptoms, and low-calorie diets are inadequate.
Question 2 of 5
A client with a history of lung cancer is admitted with complaints of hemoptysis. The nurse should give priority to:
Correct Answer: A
Rationale: Hemoptysis in lung cancer indicates potential airway compromise, so monitoring respiratory status is the priority.
Question 3 of 5
A 28-year-old woman was admitted to the hospital for a thyroidectomy. Postoperatively she is taken to the postanesthesia care unit for several hours. In preparing for the client's return to her room, which nursing measure best demonstrates the nurse's thorough understanding of possible postthyroidectomy complications?
Correct Answer: C
Rationale: Dressing changes are done as necessary for bleeding. However, frequently, post-thyroidectomy bleeding may not be visible on the dressing, but blood may drain down the back of the neck by gravity. Narcotics are administered for acute pain as necessary. They are not necessarily given on return of the client to her room. The most serious postthyroidectomy complication is ineffective airway and breathing pattern related to tracheal compression and edema. A tracheostomy set, O2, and suction should be available at bedside for at least the first 24 hours postoperatively. Impaired verbal communication may occur due to laryngeal edema or nerve damage, but most commonly, it occurs due to endotracheal intubation. The client is usually able to communicate but is hoarse.
Question 4 of 5
The nurse is caring for a client with a history of a spinal fusion. The client complains of back pain. The nurse should:
Correct Answer: D
Rationale: Back pain post-spinal fusion may indicate complications like hardware failure or infection, requiring immediate physician notification. Compresses, rest, and acetaminophen are insufficient.
Question 5 of 5
Pin care is a part of the care plan for a client who is in skeletal traction. When assessing the site of pin insertion, which one of the following findings would the nurse know as an indicator of normal wound healing?
Correct Answer: B
Rationale: Exudate (moist, active drainage) is a clinical sign of wound infection. Crust (dry, scaly) is part of the normal stages of wound healing and should not be removed from around the pin site. It usually sloughs off after the underlying tissue has healed. Edema (swelling) is a clinical sign of wound infection. Erythema (redness) is a clinical sign of wound infection.